Transarterial chemoembolization using
doxorubicin (TACE-DOX) is an effective
therapy for advanced
hepatocellular carcinoma (HCC). However, there are limited options for patients with TACE refractoriness. We compared the effectiveness between
sorafenib and transarterial chemolipiodolization using
epirubicin and
cisplatin combined with systemic infusion of
5-fluorouracil (5-FU; TACL-ECF) in patients with previous TACE-DOX refractoriness. We retrospectively analyzed 742 consecutively enrolled cohort patients who received TACE-DOX as the first-line
therapy for HCC. Among the 94 patients who failed with TACE-DOX, 49 patients were treated with TACL-ECF and 45 patients were treated with
sorafenib as a rescue
therapy. The TACL-
ECF regimen comprised transarterial infusion of
epirubicin and
cisplatin combined with systemic infusion of
5-FU. Of the 94 patients, 22 and 72 patients were in Barcelona Clinic
Liver Cancer stages B and C, respectively; 66% patients were classified as having Child-Pugh class A (
CPC A). Overall survival (OS) after rescue
therapy did not differ between the
sorafenib and TACL-ECF groups (4.1 months vs 6.4 months, P = .355). Progression-free survival (PFS) did not differ between the
sorafenib and TACL-ECF groups (2.8 months vs 3.5 months, P = .629). Adverse events of CTC grade 3/4 occurred more frequently in the
sorafenib group than in the TACL-ECF group (P = .024). The present study showed that the OS and PFS did not differ between patients given rescue TACL-ECF
therapy and those given
sorafenib therapy. The TACL-ECF treatment was better tolerated than
sorafenib. The TACL-ECF might be considered as an alternative
therapy for the patients with TACE-DOX refractoriness, especially
CPC B and
sorafenib-intolerant patients.